Midregional proadrenomedullin and growth differentiation factor-15 are not influenced by obesity in heart failure patients

Clin Res Cardiol. 2017 Jun;106(6):401-410. doi: 10.1007/s00392-016-1066-x. Epub 2016 Dec 21.


Background: Obesity is a risk factor for heart failure (HF) and identification of symptomatic, and obese HF patients are challenging, because obesity can mimic HF symptoms. We aimed to evaluate novel biomarkers for HF in obese subjects of the general population.

Methods: Midregional proadrenomedullin (MR-proADM), growth differentiation factor-15 (GDF-15), midregional pro-atrial natriuretic peptide (MR-proANP), and NT-proBNP were measured in 5000 individuals of the population-based Gutenberg Health Study (GHS), including 1204 obese individuals (BMI ≥ 30 kg/m2) and 107 individuals with HF.

Results: NT-proBNP and MR-proANP were lower in obese vs. non-obese HF individuals (p = 0.013 and p = 0.01, respectively), whereas GDF-15 was similar and MR-proADM was higher in obese vs. non-obese HF individuals. All biomarkers increased the odds ratio (OR) for prevalent HF. For NT-proBNP and MR-proANP, this increase was lower in obese vs. non-obese individuals, whereas it was comparable for MR-proADM and GDF-15. All biomarkers were associated with increased all-cause mortality (median follow-up 7.3 years, 211 events). Results were validated in 8373 individuals (n = 1734 with BMI ≥ 30 kg/m2) of the FINRISK study with a median follow-up of 13.8 years (1030 events). Using a dichotomized biomarker cutoff for HF, the best predictor for all-cause mortality in obese subjects was GDF-15 (p < 0.001).

Conclusion: All biomarkers were associated with HF and higher risk for all-cause mortality in the general population. In contrast to the natriuretic peptides NT-proBNP and MR-proANP, the novel biomarkers MR-proADM and GDF-15 were not lower in obese HF individuals, indicating their potential to facilitate HF diagnosis and prognosis in an increasingly obese HF population.

Keywords: Growth differentiation factor-15; Heart failure; MR-proADM; NT-proBNP; Natriuretic peptides; Obesity.

MeSH terms

  • Adrenomedullin / blood*
  • Aged
  • Atrial Natriuretic Factor / blood
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Growth Differentiation Factor 15 / blood*
  • Heart Failure / blood
  • Heart Failure / diagnosis*
  • Heart Failure / mortality
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Obesity / blood
  • Obesity / complications*
  • Obesity / mortality
  • Peptide Fragments / blood
  • Prognosis
  • Prospective Studies
  • Protein Precursors / blood*
  • Risk Factors


  • Biomarkers
  • GDF15 protein, human
  • Growth Differentiation Factor 15
  • Peptide Fragments
  • Protein Precursors
  • pro-brain natriuretic peptide (1-76)
  • proadrenomedullin
  • Natriuretic Peptide, Brain
  • Adrenomedullin
  • Atrial Natriuretic Factor